30 January 2008

"Low-tech" mirror therapy shows promise in amputee treatment

Navy Cmdr. (Dr.) Jack Tsao shows Army Sgt. Nicholas Paupore how to perform mirror therapy to treat phantom pain in his amputated right leg Jan. 15 at Walter Reed Army Medical Center in Washington, D.C. (Defense Department photo/Donna Miles)


Sergeant Paupore said he was skeptical when Navy Cmdr. (Dr.) Jack Tsao suggested using a mirror to help him deal with excruciating pain he continued feeling in his missing right leg.

The phenomenon, called "phantom limb pain," plagues as many as half of all amputees, likely the result of a faulty signal between the brain and the missing appendage, Commander Tsao said. Neurons in the brain continue sending out signals to a limb that's no longer there. As a result, amputees can feel discomfort or pain and, in some cases, the sense that their missing limb is stuck in an uncomfortable position.

For Sergeant Paupore, a 101st Airborne Division artilleryman who was serving on a military transition team training Iraqi troops when he was wounded in July 2006, the pain felt like electric shocks or knives stabbing into his missing leg.

"It felt like someone ... was putting an electrode on the back of my ankle," he said.

Sergeant Paupore tried several different painkillers, including morphine, but none gave him relief.
Sitting on a hospital bed with his legs fully extended, Sergeant Paupore demonstrated the therapy. He put a standard 6-foot-long mirror lengthwise between his left leg and the residual stump on his right side, with the mirror reflecting the intact leg. He moved the leg, watching the movement in the mirror and imagining that his missing leg was making the movements.

The very first time he tried it, Sergeant Paupore felt something happening.

"The stump started firing off right away," he said. "It got a little uncomfortable."
More than a year after completing his mirror therapy, Sergeant Paupore said he still experiences occasional phantom pain, but "only once in a great while." The pain is far less severe than before the mirror therapy, and Sergeant Paupore is off painkillers altogether.

"It tricks your brain into thinking your leg is still there, so it's not misfiring," he said. "I don't know how it works, but it works."

Sergeant Paupore said he encourages other amputees suffering from phantom pain to give mirror therapy a try.

"I've always recommended it to them," he said. "At least give it a try. Some people may get mild help out of it; some may get extraordinary help out of it."

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